Physicians

Request for a Medical Exception to the COVID-19 Vaccine Requirement

Documents and Forms

Document Name Document Type
Physicians Form
Medical Exception to COVID Vaccination Requirement Medical Exception to COVID Vaccination Requirement OCC Fillable Form Oct 2021.pdf Form
Medical Exception to COVID Vaccination Requirement Medical Exception to COVID Vaccination Requirement OCC Fillable Form Oct 2021.pdf Form

Information Collection (IC) Details

IC Title:	Physicians	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	N/A	Medical Exception to COVID Vaccination Requirement	Medical Exception to COVID Vaccination Requirement OCC Fillable Form Oct 2021.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 66	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	66	66
Annual IC Time Burden (Hours)	33	33
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.